The artificial pancreas in type 1 diabetes therapy

In response to blood-glucose levels, the artificial pancreas would determine how much insulin should be automatically administered--promising better quality of life for individuals with type 1 diabetes.

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Insulin has been used in clinical practice to treat patients with type 1 diabetes, where insulin production is deficient or non-existent, for almost 100 years, and huge advances in diabetes technology have been made during this time. Yet not too long ago the concept of an artificial pancreas would have seemed implausible. How could a device be developed that continuously measures blood glucose levels, determines the amount of insulin required by the body and administers the correct amount of insulin without any input from the patient? The development of this device, known as the closed-loop artificial pancreas system, however, is well and truly underway (‘closed-loop’ referring to the fact that no action is required by the patient). In a review in Diabetologia, “Coming of age: the artificial pancreas for type 1 diabetes,” authors Hood Thabit and Roman Hovorka update us on the advances being made in artificial pancreas technology and the challenges that have been faced along the way.

In terms of their primary therapeutic aim, glucose management, these devices have been shown to control glucose levels to a degree that is equal to or better than existing technologies, and reduce the risk of hypoglycaemia. There is also some indication that these devices are beneficial from a psychological perspective, because they may allow patients to have ‘time off’ from the demands of diabetes and improve quality of life. Moreover, the artificial pancreas fares well compared with current biological alternatives: whereas whole organ pancreas transplantation is a majorly invasive procedure, the artificial pancreas is worn externally and is minimally invasive. In addition, the success rate of the artificial pancreas is much higher than that of islet cell allotransplantation.

So why aren’t all people with type 1 diabetes using this innovative device? As discussed by Thabit and Hovorka, several barriers still need to be overcome to enable wide availability of the artificial pancreas. For example, technological advancements are required to improve insulin delivery, and the cost-effectiveness of closed-loop systems needs to be determined to support access and reimbursement to healthcare users and funders, respectively. In addition, further studies are required to elucidate whether certain subpopulations may benefit more from use of the artificial pancreas, for example, very young people or pregnant women with type 1 diabetes. Nonetheless, significant milestones have been achieved in the past decade, with research moving from laboratory to free-living unsupervised home settings, and it is anticipated, in the not too distant future, that closed-loop technologies will prove to be a viable alternative for the treatment of type 1 diabetes.

By: Ben Bishop


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